Abstract

Societies in all parts of the world have used substances to suppress pain and sorrow and also to get pleasurable sensations. A cross-sectional community based field survey were conducted to find out the socio-demographic factors contributing to the habit of drug abuse through door to door visit, to interview all individuals of either sex aged 15 and above in the selected sample household to enquire about drug abuse & their socio-demographic factors with structured proforma by two stage systematic sampling method, in the urban slum community of Malvani in P-North ward of Mumbai. The data collected were analyzed with the help of Mean , Standard deviation, Percentage, Chi-Square (χ2) test and Standard error of proportion. 49.7% were found positive for any type of either single or multiple drug abuse habit. 59.8% drug abusers were in the age group 15 to 34 yrs. 72.1% of drug abusers were either illiterate or primary or middle school educated. 53.1% drug abusers belonged to semiskilled group while 27.2% belonged to unemployed group. 65.2% males were having age of starting any drug in the age group 15-24 yrs. In males, reason of starting drug abuse were 81% due to peer pressure. Our results indicate that early age, illiteracy, low working status & poverty is the main socio-demographic factor for drug abuse. Peer pressure is playing very important role in initiation of any type of drug abuse.

Keywords

Drug abuse, socio-demographic factors, urban slum, cross sectional.

Introduction

The abuse of drugs and alcohol is an international
problem which affects almost every country in the world,
both developed and developing. Many health problems
and even deaths associated with such abuse are the result
of a complex interaction between the drug (and its pharmaceutical
and toxicological properties), the individual
(and his or her personality and health status) and the
setting in which the drug is taken.

Societies in all parts of the world have used substances
that suppress pain and sorrow and also provide
pleasurable sensations when consumed. The oldest are
those obtained from the cannabis plant, the opium poppy
and the coca bush. Archaeological evidence indicates
that cannabis cultivation dates back to 6000 B.C.; religious
and mystical use of cannabis in Indian societies
was reported from about the 7th century A.D.[1].

Around the 9th century Arab traders first brought the
opium to India via the west Coast and its primary use
was for medicinal purposes. By the 10th century opium
use was widespread and included social use. The first recorded
mention of opium as a product, and its cultivation,
was in the early 14th century; the poppies were
grown along the west seacoast at Cambay and Malwa [2].
With the first Moghul dynasty under the reign of Babar
(1524-1530) poppy cultivation and sale of opium became
state monopolies and soon were an important article of
trade with China and other eastern countries [2]. The British
East India Company took over the opium monopoly in
1757 and the British attempted to popularize its use to
increase revenue. In Bengal, the land designated for
opium growing stretched for 500 miles with more than a
million registered farmers growing opium plants for the
East India Company in 500,000 acres of prime land [2,3].
In India drugs are often used in open public places such as
the roadside, parks, playgrounds and market complexes.
Other favored sites include abandoned or under construction buildings, public toilets, at home, offices,
railway yards, and burial grounds. Cannabis is frequently
mixed with tobacco or it can be made into a powder by
removing the seeds, placing them in a chillum made of
earthen clay and then lighting it.

India is the biggest supplier of licit demand for opium
required primarily for medicinal purposes. Besides this,
India is located close to the major poppy growing areas of
the world, with “Golden Crescent” (stretching from the
Pakistan-Afghanistan border to northern part of Iran) on
the Northwest and “Golden Triangle” (hilly tract lying in
between Myanmar, Laos and Thailand) on the North–
East. This makes India vulnerable to drug abuse particularly
in poppy growing areas and along the transit/
trafficking routes. Acetic Anhydride is manufactured
in large quantities by India & China for use in
textile industry. Acetic Anhydride is also diverted for
synthesizing heroin from raw opium.

Recognizing the seriousness of the multi-faceted implications
of the incidence of alcoholism and drug abuse in the
country, the Ministry of Social Justice and Empowerment,
Government of India launched a scheme for prohibition
and drug abuse prevention in the year 1985-86. Since then
the ministry has been promoting a community based approach
towards the identification, treatment and rehabilitations
of addicts. In the larger social context, a major
thrust has to be given to preventive education so as to
ensure that those at risk are helped before they reach a
point of no return.

Alcohol has been in use in most societies for ages, regulated
by traditions, social norms and natural limitations.
The ill effects of alcohol consumption can arise from a
single bout of drinking or from the long term effects of
alcohol consumption in the form of health, social and
economic effects. Alcohol use is one of the major causes
of the global disease burden.

Tobacco was introduced into Europe in the late 15th century
from America as custom of smoking dried tobacco
leaves. Sometimes in the late 16th or early 17th century,
Portuguese traders introduced it into India during Emperor
Jehangir’s rule. The emperor was gifted tobacco
during his “ durbar” in Agra Fort (Jehangir’s Capital).
Since then tobacco use has spread with remarkable rapidity
seeping into all sections of society [4].

Initially, tobacco was smoked in India, but it was later
used for chewing and application over the teeth and
gingiva as well ( smokeless form ). In course of time, a
large spectrum of methods of use were developed . It is
estimated that among the 400 million individuals aged 15
years and over in India, 42% use tobacco in one form or
other. 72% of tobacco users smoke bidi, 12% smoke cigarette and 16% use tobacco in smokeless form [4].
India is the 3rd largest producer of tobacco after China
and USA [5]. Tobacco products consumption causes
around 3 million death a year with 0.5 million are
among women and toll is rising every year with 70%
of those deaths occurring in developing countries and
is expected to rise from 3 to 10 million by 2020 year
[6]. Table 1 shows the existing profile of current drug
users (Source: NHS[7] ).

Table 1: Profile of current Drug Users.

In India, although statistics are available on infectious
diseases, no separate data is available for persons
with alcoholism and drug abuse. These are thus
grouped together with psychiatric diseases for coding
and tabulation purposes. Psychological symptoms,
which include depression, anxiety, memory defects,
sexual inadequacy and personality problems have also
been reported as health consequences of drug abuse.
Frequent absenteeism due to drug abuse has also been
reported.

Abuse remains critical problems in most countries, not at
least because of their far reaching social and economic
repercussions. The use of drugs and illicit substances
starts during adolescence and young adulthood and hence
emphasizes the need for preventive education at this impressionable
age. The choice of drug used depends on
various factors such as sex, social customs, economic
status, peer usage and popularity and easy availability.
Socio-economic and health hazards resulting from substance
use are enormous and intensified further due to
pre-existing overpopulation and low socio-economic development.
In this background, I tried to find out the
socio-demographic factors contributing to the habit of
drug abuse in the urban slum community in Mumbai.

Material and Methods

This study was cross-sectional field survey through
door to door visit to interview all individuals of either
sex aged 15 and above in the selected sample household
to enquire about drug abuse & their sociodemographic
factors with structured proforma by two
stage systematic sampling method. We studied urban
slum community, Malvani in P-North ward of Mumbai.
An Urban Health Centre has been established by
P.S.M. Department of Seth G.S. Medical College at
Malvani in the year 1978 to offer comprehensive health
care services to about 1.5 to 2 lakh poor and needy
people living in slum. This field practice area of
Health Centre is divided into 8 colonies -New Collectors
Compound (NCC), Old Collectors Compound
(OCC), Maharashtra Housing Board Colony (MHBC),
Squatter’s Colony, Samna Nagar, Bombay Municipal
Colony (BMC), New Bhabrekar Nagar Colony including Ambujwadi, Akashwani Area. In stage I sampling,
by Simple Random Sampling, for study purpose, 4 areas
were selected by lottery method out of 7 areas
(Samna Nagar were clubbed with MHB Colony because
it was having just 200 houses ad near to MHB
Colony).

Four selected areas were –

a. MHB Colony- It constitutes 158 chawls, each
having 16 houses, approximately 2528 houses and
200 houses of Samna Nagar has been clubbed
with this area, so total 2728 houses. Samna Nagar
is very well organized in the 10 chawls & 20 houses
in each chawl.

b. NCC Colony- Total plots in NCC were numbered
upto 73, but Plot no. 1 is Garden, 27 & 28
for Maulana Azad Maternity Hospital, 49 No. Plot
is not numbered. Usually 115-125 houses in each
Plot, but some of the houses have become double
storey & separate family is staying there, so 180
houses were considered in each plot which comes
to 69 × 180 = 12420 houses.

d. Ambujwadi- It constitutes 3000 houses, but situated
in an unorganized manner. Because this is unauthorized
slum so MCGM is not providing any
basic amenities.

Study Population

Family size was considered as 6 after consultation
with health post personnel for this study area. Total
population were calculated on this data. As per data
from office of Registrar General, India [8] 34% population
belonged to age group 0-14 yrs, and 66% population
aged above 15 yrs. For this age group 1.07
male/female were present. Based on this Target Population
were calculated for all the area and shown in Table
2.

Table 2: Calculation of Target population for study area.

Table 3: Socio – Demographic details of study populations.

In stage II sampling, sample size were determined as
994 based on prevalence of Alcohol & other drugs i.e.
28.7% [7] with 10% allowable error and rounded to
1000. From all the 4 areas sample size were determined
based on proportionate to population size (PPS)
and then systematic sampling method were applied in
each area. Sampling interval were calculated for each
area.

Sample size for diff. Area = Area population × Total
sample size/ Total population.

For MHB, Sample size = 115, No. of households
required to be visited = 29 & Household sampling
interval = 94. First house were selected by last
digit of randomly picked currency note, it was 7,
then other houses were selected by adding 94 to 7
and so on … ( 7th, 101st, 195th, 289th ……).

For NCC, Sample size = 525, No. of households
required to be visited = 132 & Household sampling
interval =94. First house were selected by last two
digit of randomly picked currency note, it was 27,
then other house were selected by adding 94 to 27
i.e. 121 and every 27th & 121th house from every
plot for simplicity ( because every plot had around
180 houses, so instead of 94, 90th were considered as
household sampling interval) were taken for study.

For Akashwani, Sample size = 230, No. of households
required to be visited = 58 & Household sampling
interval =94. First house were selected by
last digit of randomly picked currency note, it
was 9, then other houses were selected by adding
94 to 9 and so on…(9th, 103rd, 197th, 291st ……).

For Ambujwadi, Sample size = 127 (130 were
taken), No. of households required to be visited = 32
& Household sampling interval =94. First house
were selected by last digit of randomly picked
currency note, it was 2, then other houses were
selected by adding 94 to 2 and so on…( 2nd, 96th,
190th, 284th)

For all Areas, if the concerned houses were
closed, then next immediate to the selected house
were visited and considered for the study. If next
house was also found locked, then next to that house
were taken for study.

Inclusion criteria for the study, all the male & female
of age 15 and above, who were present in the selected
houses were interviewed, in each houses on an average
2 to 10 people were of above criteria. Exclusion criteria
were unwillingness to participate. In some houses
subjects were not willing to participate in the study, but
in that case we left that house and went to next open
houses. In some of visited houses only female member
were present, male earning member were out for duty, in
that case available members were interviewed.

During visit to the sample houses, self-introduction
was given to the subjects and family members and aim
of study was explained to them in detail. Initial rapport
with the subjects were established by some informal
conversation and then interview were taken. The data collected by above method were compiled.
The data were analyzed with the help of mean , standard
deviation, percentage, chi-square (χ2) test and
standard error of proportion.

Results

In this study, all the respondents were ranged between
minimum age 15 yr and maximum age 89 yr i.e. range
of 74. The mean age of the study population were
32.8 ± 13.48 yr, median was 30 yr & mode was 20 yr.
The frequency of distribution of respondents according
to age in the community decreases as age increases,
61.8% are between age group 15 to 34, around 20%
(19.1) in the middle age group i.e. 35- 44, and rest
19.1% belong to more than 45 yrs. Male / Female ratio
were 1.247 i.e. 1.25, it means for every 4 female, there
is 5 male present , this is very high with respect to national
M/F ratio which is 1.07, this high ratio may be due to want of male child by the community. Also due to
selective migration of males to Mumbai to earn a
living (for livelihood), leaving behind their wives /
children in their native places. It was observed that
more males (71%) fall in 15 to 34 yrs of age while only
50% females fall under 15 to 34 yrs of age. In middle
age group (35-44) females are just double of male population.
68.1 % females were married while 50.3 %
males were married. 58.2 % were married in total
population. In 1000 respondents, 381 (38.1%) were
Hindus, while 593 (59.3%) were Muslims. 12 (1.2 %)
were Buddists & 14 (1.4%) were Christians. Data were
collected from 1000 individuals aged above 15 yrs for
any type of drug abuse habit and it was observed that
497 (49.7%) were found positive for any type of either
single or multiple drug abuse habit. Standard error of
Proportion 1.58, 95% Confidence Interval of Prevalence
of drug abuse = 49.7 ± 3.16.

1. 31.2% drug abusers were in the age group 25 to
34 yrs & 28.6% were in the age group 15 to 24
yrs, In other words 59.8% drug abusers were in
the age group 15 to 34 yrs. In 35 to 44 age
groups drug abusers are less i.e. 15.5% as compared
with non drug abusers (22.7%). After 45
yr, drug abusers are again more than non
abusers.

2. It was observed that 36.6 % drug abusers
were Hindus, while 61.6 % Muslims. It may
appear that in Muslims drug abuse were
more than Hindus, but it is due to high proportion
of Muslim population in the area. In
Muslim population it is slightly higher prevalence
of drug abuse (61.6) than the population
ratio i.e. 59.3%.

3. It was observed that, 24.7% drug abusers
were illiterate as compared to 16.9 % in non
drug abusers group. 72.1% of drug abusers
were either illiterate or primary or middle
school educated. As the literacy increases,
drug abusers decreases. In middle & high
school educated, drug abusers were less in
comparison with non drug abusers. In post
graduates no drug abusers were found.

4. 53.1% drug abusers belonged to Semiskilled
group while 27.2% belonged to Unemployed
group. In non drug abusers, 53.3% from Unemployed
group while 31% belonged to Semiskilled
group. Housewives were considered in
unemployed group. Not a single professional
were found in the area.

Out of 555 Males, 370 (66.7%) were having drug
abuse habit, while in case of females, out of 445, only
28.5% were abusing any type of drugs. Out of total
drug abusers (497), 370 (74.5%) were males and only
127 (25.5%) were females. When it was compared with
drug abusers and non abusers according to Kuppuswamy
scale for socio-economic status, it was observed
that 44.26% drug abusers belonged to Upper
lower class in comparison with 37.97% to non drug
abusers (Table 4).

Table 4: Distribution of respondents according to Modified Kuppuswamy scale for
Socio-economic Status and drug abuse habit of any type.

In Females, 97% were having Smokeless tobacco habit
in which masheri were 43 (32%), tobacco with pan were
35 (26%), khaini 28 (21%) & gutka 22 (16.5%). In
Males, 41% were having Smokeless tobacco habit, followed
by 27.8% tobacco smoking, then by alcohol
16.5%, & charas 8% (Table 5).

Table 5: Distribution of persons according to sex and drug abuse habit of any type. (Multiple Response)

65.2% males were having age of starting any drug in
the age group 15-24 yrs. 19.6% males started even
before 15yrs, minimum age of starting drug abuse
were 7 yrs. In females, age of starting were shifted
towards later age i.e. 37.6% started in 15-24 yrs, 30.4%
started in 25- 34 yrs, and 21.6% started in more than
35 yrs of age. Only 10.4% females were started in before
15 yrs of age .

In Males, reason of starting drug abuse were 81%
peer pressure, While in case of females 26% were
started due to peer pressure & other 26% were started
due to toothache. Addiction was the main reason for
continuation of drugs as 66.8%,followed by Pleasure
14.7%, Fun 10.9% & other causes 6.2%. It was observed
that, 57.7% drug abusers made efforts to quit
drug abuse but did not succeed. 61.6% males and 46.4% females had made efforts to quit the habit. In
24.7% of drug abusers, past history of drug abuse
habit were present.

Discussion

Age groups of drug abusers and non drug abusers
was statistically significant with χ2 = 38.6, and df = 5,
P value is less than 0.001 ( Table 3). 59.8% drug
abusers were in the age group 15 to 34 yrs. It could be
general finding that drug abuse is more common in
early age groups. More males (74.5%) had drug
abuse habit than females (25.5%) This difference
may be due to males having more exposure to outside
world in comparison of females. So males are
more vulnerable to drug abuse in comparison to females.
36.6 % drug abusers were Hindus, while 61.6
% Muslims. It may appear that in Muslims drug
abuse were more than Hindus, but it is due to high
proportion of Muslim population in the area. It was
statistically not significant as χ2 = 4.617, and df = 3,
P value was more than 0.05 (Table 3). 72.1% of
drug abusers were either illiterate or primary or middle
school educated, relation between literacy and drug
abuse were statistically significant with χ2 = 43.546,
and df = 6, P value is less than 0.001 (Table 3). As
the literacy increases, drug abusers decreases. In NHS
report [7], about 20% were illiterate, about 18% had
studied up to primary level, an additional 25% up to
middle level and very few (about 8%) were graduates
and above. In our study, Relation between working
status and drug abuse were statistically significant
with χ2 = 77.762, and df = 8, P value is less than
0.001 (Table 3).

By applying Modified Kuppuswamy Scale for determining
Socio-economic status which takes account of
Education, Occupation of the head of the family and
per capita income, it was observed that 99% of males
belonged to only three groups i.e. Upper Lower
(39.45%), Lower Middle (28.3%) & Upper Middle
(31.2%). 44.26% drug abusers belonged to Upper
lower class in comparison with 37.97% to non drug
abusers. Relation between socio-economic status and
drug abuse habit were statistically not significant.

It was observed that different drug abuse were
prevalent in the area. When 1000 person were interviewed,
it was found that smokeless tobacco were
more prevalent in the area i.e. 43.7%, while smoking
tobacco were 21%, alcohol were 12.2%, charas 5.9%,
ganja 2.5%, brown sugar 1.7% & opium and others
were 0.8% (Table 5). These results were based on
multiple response of respondents. Mostly, alcohol,
charas, ganja, brown sugar & opium were found in the
combination rather than single habit. In smokeless tobacco out of 437 respondents, gutka habit were more
prevalent i.e. 156 (35.7%), followed by khaini 107
(24.5%), then by tobacco with pan 78 (17.8%) & masheri
51 (11.7%), others 45 (10.3%). In smoking tobacco, filtered
cigarette were more prevalent 118 (56.2% ) followed
by bidi 83 (39.5%) & others 9 (4.3%). One
study among the 400 million individuals aged 15 years
and over in India, showed that 42% use tobacco in one
form or other. Some 72% of tobacco users smoke bidi,
12% smoke cigarette and 16% use tobacco in smokeless
form [4].

In general population surveys [7], the prevalence of
alcohol abuse varied between 4.2 and 30.7 percent,
cannabis abuse between 0 and 5.8 percent, heroine
abuse between 0 and 1.3 percent and other opiates
between 0 and 10.2 percent. It was apparent that there
were regional variations as regards the prevalence of
the problem. In NHS report [7], 55.8% were tobacco
users, 21.4% were alcohol users, 3% cannabis, 0.3%
were opiates users and 3.6% were on any other Illicit
Drug. One study in urban slums of Sambalpur
showed 43.4% prevalence of substance abuse [9], this
is slightly lower than present study prevalence
49.7%.

One cross sectional study conducted in urban area in
Mumbai, a total of 211 males and 165 females participant
showed prevalence of alcohol use in males = 18.96 %, in
females = 0.61 %, tobacco prevalence in males = 25.12
%, females = 16.36 %, total males + females = 17.02 %,
8.08 % of males smoked (cigarette, beedi) while 17.54 %
used smokeless tobacco (pan, masheri, chuna, gutka);
none of the females smoked while 16.36 % used smokeless
tobacco, total charas users for males was 0.47 %, no
Intravenous Drug Users were reported, age of initiation of
use was 21 - 30 years for most drugs except whiskey for
which it was 31 - 40 years [10]. In the present study,
97% females drug abusers were using smokeless tobacco.
65.2% males were having age of starting any
drug in the age group 15-24 yrs. 19.6% males started
even before 15yrs, minimum age of starting drug
abuse were 7 yrs. In females, age of starting were
shifted towards later age i.e. 37.6% started in 15-24 yrs,
30.4% started in 25- 34 yrs, and 21.6% started in more
than 35 yrs of age. Only 10.4% females were started
in before 15 yrs of age. Study done by Sinha [11]
had found prevalence of smoking to be 19.4% in
school students of Bihar and also showed that 51.7%
of school children abusing substances had a parent
who smoked. In NHS report [7], it was shown that the
onset of drug use begins in early twenties.

In Males, reason of starting drug abuse were 81%
peer pressure, While in case of females 26% were
started due to peer pressure & other 26% were started
due to toothache. Other studies showed peer group
pressure for initiation and continuation of substance abuse 47.5% [12] and 48.3% [9], which is less than
our study result. In another study done by TIFR, regarding
tobacco, most important reason of starting is
tooth related complaints (48%), followed by peer
group influence (38%). Tooth related problems were
common reasons for women (92%), whereas for men
peer-group influence (58%) were most important [4].
Addiction was the main reason for continuation of
drugs as 66.8%, followed by Pleasure 14.7%, Fun
10.9% & other causes 6.2%.

Our results indicate that early age, illiteracy, low working
status & poverty is the main socio-demographic
factors for drug abuse. Peer pressure is playing very
important role in initiation of any type of drug
abuse. As age of starting drug abuse were 15-24yrs
(65.2%) & before 15 (19.6%), so preventive measures
should target this population. At schools & colleges,
Teachers & Professors should tell accurate scientific
information and discuss the broad risk factors &
harms associated with drug abuse to their students &
should himself refrain from smoking. For this Teachers
& Professors should be provided regular training.
Parents should be regularly educated by health personnel
regarding ill effects of drug abuse & current
situation of it in the community to educate their children
and show role model to them, because children
learns from and imitate their parents. In 81% peer
pressure was the reason for starting drug abuse, so
young peer groups should be targeted by health personnel;
dissemination of information and harmful effects
of drug abuse should be discussed.

UNODC and MSJE, GOI joint project. The Extent, Pattern and Trends of Drug Abuse in India. United Nations Office on Drugs and Crime, Regional Office for South Asia, and Ministry of Social Justice and Empowerment, Government of India, New Delhi.2004. pp 19- 84.